wrmedic82

What about hyperkalemia or magnesium sulfate toxicity among other problems? "Asking around allot" should include doing some actual foot work and researching yourself, never take anything said on public forums as gospel until you can verify what is said.

Take care,

chbare.

how are you going to even know other than seeing peaked t-waves on ECG or w/o a lab spread sheet produced by dialysis center or NH?

Dose for what exactly? I am a little confused regarding what you are using Calcium Chloride for? When talking about giving 10% CaCl- to an acutely ill patient, you may expect to give much more than 2-4 mg. The standard concentration of your "amp" of CaCl- is typically 10%. This gives you 100 mg/ml of calcium. You are suggesting giving significantly less than 1 ml of CaCl-? I think you are getting your numbers crossed or perhaps confusing ml with mg?

Take care,

chbare.

The only thing I would think that you may need to give calcium chloride for is accidental calcium channel blocker overdose. Im sure that there are other condition that I will find as I research more. But that in the EMS setting is neither here nor there, we are not going to know that the patient is going to need it until lab work is done at the hospital. or in a whirlybird setting on a CC transfer.

here is a link to another forum and again the answers are not clear http://forums.firehouse.com/showthread.php?t=43590

W/o watching or reading in short Paramedics should decide who gos to the hospital by ambulance. We are not taxis.

I agree with you to a point. 9/10 call is BS anyway. However I do believe that w/o equipment to definitively rule out the worst case scenario which most ambulances do not carry. Its usually better in some cases to transport. Other times I feel that a recommendation to a Dr office it the most appropriate. It all depends on how blatant the CC is.

Good Morning from Texas!!!!!!!!

I have been asking this question around alot and I seem to only get alot of speculation vs reason. With most medication when it comes to pediatrics, its been said that the pediatric dose should never exceed the adult dose. However in the case of calcium chloride in pediatrics the dose is 20mg/kg, however in adults its 2-4mg/kg. So what I am trying to figure out is why that is the case.

Ive heard alot of confusing reasons so whats everyones take on it.

So you always backboard everyone you find at an MVA? After all, "CYA."

To answer your question, No. Based upon the situation that was described in the forum, yes I would. It all depends on the scene, the patient, and the CC. The CC of neck or back pain gets a 1 way trip to the hospital on a backboard regardless of how BS the scene is. Case and point, Ive been on scene of a relatively minor MVC, the patient I had was a 65/f CC neck pain. We packaged her up backboard, c-collar the whole nine yards. Didnt think much of it until we got to take a look at the xray. Which to say the least was a ass puckering event as the patient had a c-4 Fx. Its just a judgement call you have to make on your own. Would I transport a patient involved in a MVC with a CC of a stubbed toe who is ambulatory on scene....Probably not. However Im sure someone has a whacky story that may make me reconsider.

Out of all the things an EMS provider might consider reporting, an illegal immigrant would be ridiculously low on the list. Usually EMS only reports if an immediate threat to someone.

It's part of that differentiating from PD, so people who are scared of PD (maybe they arrested daddy one day and kid thinks he should call for self or mom having CP) won't be scared to call EMS.

Usually these types of posts have to do with finding massive amounts of drugs or something big like that were threat isn't immediate, but still a threat. For an immigrant? Come on, now. (And you don't even know for SURE he's illegal, just saying...I mean cops could also just raid the local hardware store for the workers waiting outside, if they really wanted the illegal immigrants.)

Good Point

We are not in the transportation business we are in the Medical Profession. We are Pre-Hospital Medical Professionals and we need to start practicing medicine rather than our taxi driving skills. Transportation is just a part of our job not the job. If that is what you think our job is might be time for a job change.

We can practice medicine, but screwing around on scene delaying definitive care isnt doing the patient much good. We provide transport to the hospital as well as pre-hospital care while enroute. We can give breathing treatments all day long, as well a some steroids, but ultimately a physician has to evaluate and treat the patient according to findings we may not be able to determine in the field. Im all about practicing medicine, however sitting on scene so I can play with all my toys seems crazy. Everything can be done enroute to the hospital..Lets face it, hospitals have more resources to treat things better than we can in the field. We use medicine to attempt to get the ball rolling so definitive care than take over, and determine what further interventions may be needed. Last but not least lets be mature.

Let's see – route of choice for administration of life-saving ACLS meds, route of choice for administration of blood and blood products, route for of choice for induction of pre-surgical anesthesia for life-threatening conditions, route of choice for administration of fluids / pressors to sustain viable MAP, route of choice for administration of certain antitoxic agents, route of choice for administration of antibiotics for meningococcal septicemia, or bacterial PNA / sepsis, route of choice for the timely adminstration of thrombolytic agents for CVA / MI, etc, etc.

You could use your argument for any other single intervention out there, including O2 administration. Point being, IVs are used in conjunction with continued care, and have been integral in saving many lives. Lives which may have been lost if access was unobtainable or delayed.

ACLS is a class indeterminate intervention. There is not a shread of proof that ACLS has any effect on cardiac arrest outcomes....try again.

Blood transfusion are life sustaining, not life saving...you may also want to check into the associated complications of blood transfusions. Which is not applicable in the pre-hospital setting.

Other routes are also used that may be delayed, but are effective. Yes IV is the fastest route and the preferred route. However the uses are more for sustaining life vs saving life.

Along with any medication, it either works or it doesn't so it does not matter whether or not an IV is established or not. Its the medication doing the work, not the IV.

We can argue this one all day or call it a day.. you decide

Just food for thought, sometimes alot of artifact is attributed to lead placement. Just something to check out. If your patient is having CP. I personally would treat the patient and not the monitor. I do not see the need to dick around on scene with a ECG monitor and delaying definitive care. Another ECG will be done at the hospital anyway. So trying to figure out whether your monitor is on the fritz or not on scene is delaying care. Lets say there is no ST elevation, depression or whatever, does this completely rule out acute myocardial infarction?? Absolutely Not!!!! Do what you can and get to the hospital.

progressive thinking

Admin, can we have a weekly "silliest thing stated on an internet forum" section please?

Show me how an I.V. has ever saved a life?

Friends dont let friends work at AMR (american medical retards) lol

Just know your stuff and be able to pass their physical and your good to go.

In my opinion its about reading the scene and doing whats best for the patient, as well as you and your partner. Lets face it there are tons of people out there that freak out over stubbed toes or other related bs. If you can start a treatment at the patient's side why the hell not? Another option is to start treatment while moving the patient to the ambulance if possible. Whatever it takes to get the patient taken care of safely and efficiently without delay. Remember that EMS is in the transportation business. The hospital can do more good for the patient that any ambulance service. That is one thing alot of people in EMS forget.

Lol something I will have to add to my zombie bag for the inevitable zombie invasion...self preservation is a great thing other than the weapons needed for defense.

And yes everyone I am joking btw

EMS...You call, we haul, thats all. Unless they put law enforcement into my job description...not my problem. The only thing Im concerned with is getting that patient to the hospital and getting what can be done for the patient done. If all that can be done is a ECG, o2 and ASA. Im ok with that. An IV has never saved a life...but it does help out greatly. Definitive care is the ultimate goal. they have much better toys to play with.

Me personally I would have fully immobilized him for a couple reasons

1. He may be altered due to hypoglycemia

2. Adrinaline may mask injuries

3. Just because the patient is walking around does not R/O head, neck or back injuries.

4. Most importantly C.Y.A.

Of course everything is a case-by-case basis. It wouldn't cause further harm to fully immobilize the patient.

What alot of people get complacent about is the routine stuff. Lets face it almost everyday 911 EMS providers will encounter a MVC once or twice a shift. Its also complacency that brings cause for litigation (in the U.S.) Unless you have a X-ray machine on scene to R/O Fx to head, neck, or spine, C.Y.A. and immobilize the patient.

I couldn't agree more on that statement. Admittedly this was not a clever thing to do, but everyone here should first take the time to research the politics of meal breaks in the UK before shouting their mouths off.

Some people here are just determined to qualify my preconception of Yanks and their big mouths. Luckily, they are in the minority.

WM

My bad I wasn't aware that there is politics involved when it comes to meal breaks, especially when it comes to EMS.. Next time granny or little Tommy decides to code during my meal break...they will just have to wait. Im sure the patient and the family will understand....

Im all about making the patient as comfortable as possible. On our trucks we carry Phenergan and Zofran.

The one thing we started doing last year is moving towards Zofran ODT. We still carry the Zofran IV, but thats what we are pushing towards.

My personal experience with Zofran ODT is that is works great if the patient has nausea, but not actively vomiting. It dissolves under the tongue in about 30-45 seconds and tastes like cotton candy. The only problem I have seen is with patients actively vomiting. Its kinda pointless at that point. Most medics in our system as well as myself prefer IV Zofran.

Whats everyone elses take on it??

Just read this post and break down everything.....

OMG doesnt even describe it....since this guy has NO medical training.

http://zombiehunters.org/forum/viewtopic.p...p;sk=t&sd=a

Hmmmmmmmmmmmmmmmmmm

This seems more of gross negligence than incompetency. Incompetency would be telling the patient to walk it off or moving the patient in a way to cause further harm to the patient. In the article it never stated that the paramedic made patient contact. If anything its a breach of duty to act when he was advised that a emergency was going on, and he failed to respond to the scene. The article is not clear as to why the other vehicle did not carry the necessary equipment to treat the patient. But what is clear is that it was a vehicle used to transport patients. That which makes the crew or EMS provider in a sense liable for not having the right equipment on the truck, or sending the unit to first respond with a ambulance with the capabilities needed to treat the patient appropriately. So the bigger picture so it seems stems further than just a negligent paramedic whom decides not to respond when approached about a emergent case. I think he is wrong for what he did. But I think also he is being a patsy so to speak for an entire ems systems incompetence.

Another thing I would also like to know that is not specified in the article is whether or not he was on or off the clock during his 30 min break. If he was off the clock then the paramedic only had a ethical duty to act. If he was on the clock, then again that only goes towards gross negligence.